Parálisis diafragmática neonatal tras parto distócico: a propósito de un caso clínico

Helena Sobrero; Natalia Allio; Bernardo Berazategui; Mario Moraes

doi:10.59594/iicqp.2025.v3n2.146

Authors

Helena Sobrero Unidad Académica de Neonatología, Hospital Pereira Rossell, Montevideo 11600, Uruguay. https://orcid.org/0000-0002-6142-0717
Natalia Allio Facultad de Medicina, Universidad de la República, Montevideo 11800, Uruguay. https://orcid.org/0009-0009-7056-9511
Bernardo Berazategui Facultad de Medicina, Universidad de la República, Montevideo 11800, Uruguay. https://orcid.org/0009-0003-6804-3496
Mario Moraes Facultad de Medicina, Universidad de la República, Montevideo 11800, Uruguay. https://orcid.org/0000-0002-5174-2405

DOI:

https://doi.org/10.59594/iicqp.2025.v3n2.146

Keywords:

Infant Newborn, Diaphragmatic Paralysis, Dystocia, Case Reports

Abstract

Background: Diaphragmatic paralysis in neonates, secondary to phrenic nerve injury, is a rare but important cause of respiratory distress, particularly in the context of shoulder dystocia, and may go unnoticed in mild cases. It occurs due to lateral hyperextension of the neck during delivery, affecting the C3–C5 nerve roots, and is often associated with brachial plexus palsy.

Case presentation: We report the case of a male neonate, born after a difficult delivery, who developed mild respiratory distress at 24 hours of life. Chest radiography and ultrasonography revealed elevation of the right hemidiaphragm and absence of excursion, confirming right diaphragmatic paralysis. Management was conservative, with supplemental oxygen administered via nasal cannula, resulting in favorable clinical progression and spontaneous resolution of the condition.

Conclusion: The findings underscore the importance of considering diaphragmatic paralysis as a differential diagnosis in neonatal respiratory distress after a difficult delivery, even when symptoms are mild, to raise awareness among neonatal care professionals about an uncommon but clinically relevant complication. In addition, early imaging evaluation and conservative management are recommended in mild cases to avoid unnecessary invasive interventions.

Downloads

Download data is not yet available.

References

Contreras E, Escobar HR, Necochea KC, Castro MS, Sánchez DI, et al. Tres casos de parálisis diafragmática: utilidad del estudio electromiográfico. Rev Chil Pediatr. 2004;75(1):29-34. doi:10.4067/S0370-41062004000100007

Orizaola Ingelmo A, Pérez Santos AB, García Valle E. Parálisis diafragmática unilateral debida a distocia de parto. Rev Electron Portales Med [Internet]. 2019 [citado el 6 de junio de 2025]. Disponible en: https://www.revista-portalesmedicos.com/revista-medica/paralisis-diafragmatica-unilateral-debida-a-distocia-de-parto/

Ahmadpour-Kacho M, Zahedpasha Y, Hadipoor A, Akbarian-Rad Z. Early surgical intervention for diaphragmatic paralysis in a neonate: report of a case and literature review. Iran J Pediatr. 2011;21(1):116-20. doi: 10.1016/j.jpedsurg.2019.10.038

Stramrood CAI, Blok CA, van der Zee DC, Gerards LJ. Neonatal phrenic nerve injury due to traumatic delivery. J Perinat Med. 2009;37(3):293-6. doi: 10.1515/JPM.2009.040

Rizeq YK, Many BT, Vacek JC, Reiter AJ, Raval MV, Abdulah F, et al. Diaphragmatic paralysis after phrenic nerve injury in newborns. J Pediatr Surg. 2020;55(2):240-44. doi: 10.1016/j.jpedsurg.2019.10.038

Martínez-Ferro M, Cannizzaro C, Chattás G. Fetoneonatología Quirúrgica. Vol 1. Otras patologías diafragmáticas. Buenos Aires: Ediciones Journal; 2018. p. 481-5.

Martin RJ, Fanaroff AA, Walsh CH. Fanaroff and Martin’s Neonatal-Perinatal Medicine. Vol 1. 10a ed. Philadelphia: Elsevier Saunders; 2015. p. 1113.

Escande B, Cerveau C, Kuhn P, Astroc D, Daemgem F, Messer J. Paralysie phrénique isolée obstétricale: évolution favorable sous pression expiratoire positive par voie nasale. Arch Pediatr. 2000;7(9):965-8. doi: 10.1016/S0929-693X(00)90012-5

Blanco M, Ernest G, Salvado A, Cambursano VH, Borsini E. Utilización de la ventilación no invasiva en pacientes con parálisis diafragmática: reporte de casos. Rev Fac Cienc Med. 2017;74(1):55-9. doi:10.31053/1853.0605.v74.n1.15136

Zifko U, Hartmann M, Girsch W, Zoder G, Rokitansky A, Grisold W, Lischka A, et al. Diaphragmatic paresis in newborns due to phrenic nerve injury. Neuropediatrics. 1995;26(5):281-4. doi: 10.1055/s-2007-979774

Keller BA, Hirose S, Farmer DL. Trastornos quirúrgicos del tórax y las vías respiratorias. En: Gleason CA, Juul SE, eds. Avery. Enfermedades del recién nacido. 10a ed. Barcelona: Elsevier España; 2018. p. 722.

Abdulhayoglu E. Traumatismos obstétricos. En: Cloherty JP, Eichenwald EC, Stark AR, eds. Manual de neonatología [Internet]. 8a ed. Barcelona: Wolters Kluwer; 2017 [citado el 6 de junio de 2025]. p. 68-9. Disponible en: https://dialnet.unirioja.es/servlet/libro?codigo=825569

Ávila Reyes R, Herrera Pen M, Rivera García S, López Garrido E, Olivares Bautista D, Camacho Ramirez RI, et al. Eventración diafragmática adquirida por trauma obstétrico en un recién nacido prematuro. Pediatr Mex [Internet]. 2012 [citado el 6 de junio de 2025];14(4): 176-81. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=38059

Izquierdo Meralla A, Suárez García N, Piloña Ruiz SG, Rivera Oliva L, Breto Rodríguez AG. Distocia de hombros y eventración diafragmática. Rev Cienc Méd Pinar Río [Internet]. 2014 [citado el 6 de junio de 2025];18(1):168-74. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=47832

Murty VS, Ram KD. Phrenic nerve palsy: a rare cause of respiratory distress in newborn. J Pediatr Neurosci. 2012;7(3):225-7. doi: 10.4103/1817-1745.106487

Gurewitsch ED, Kim EJ, Yang JH, Outland KE, McDonald MK, Allen RH. Comparing McRoberts' and Rubin's maneuvers for initial management of shoulder dystocia: an objective evaluation. Am J Obstet Gynecol. 2005;192(1):153-60. doi:10.1016/j.ajog.2004.05.055